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 Upper motor neurone lesion – exam presentation

How to present a patient with an upper motor neurone (UMN) lesion for doctors, medical school exams, OSCEs, MRCP PACES and USMLE


  • I examined Mrs Magee’s legs
  • There was a walking frame beside the bed and she was unable to walk without support as she could not use her left leg.
  • Her left leg was extended when she lay down. There was no wasting and no fasciculations.
  • Tone was normal on the right but increased on the left in all muscle groups.
  • Power was normal on the right. On the left, power was decreased at 0 out of 5 in all muscle groups tested.
  • Reflexes were normal on the right. On the left, the reflexes were brisk.
  • Sensation was normal.
  • Coordination was normal on the right but could not be assessed on the left.
  • In summary she had a spastic paresis of the left leg with increased reflexes. These signs are consistent with a right-sided upper motor lesion. A possible diagnosis is a lesion affecting the right cerebral cortex or cerebrospinal tract, such as a stroke.


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Perfect revision for medical student finals, OSCES and PACES